| NPI | 1174929400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15840) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC32923) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2024-05-01 |